Hemichorea caused by nonketotic hyperosmolar state: A case report and review of the literature

Dance of the Sugar: Two Case Reports of Chorea Associated With Nonketotic Hyperglycemia

Hyperglycemia-induced chorea/ballism is a rare clinical entity that often occurs in the setting of nonketotic hyperglycemia due to poor glycemic control in elderly patients with a diagnosis of type 2 diabetes mellitus (DM). This condition is typically characterized by hemichorea/hemiballism and unique brain imaging findings in the contralateral basal ganglia. Treatment involves the correction of blood glucose, and most cases resolve without additional therapy. Here we report two cases of this condition in which patients with type 2 DM presented with nonketotic hyperglycemia and typical neuroimaging findings. Although rare, clinicians should be aware of this condition in patients with diabetes who present with sudden abnormal movements since its prompt diagnosis and treatment often lead to a favorable outcome.

Hemiballism and chorea with acute/subacute onset: a retrospective series

INTRODUCTION

Chorea is a hyperkinetic movement disorder with sudden, irregular, random, dance-like involuntary movements, and ballism is usually one-sided, high-amplitude movements at the proximal of the extremities. In the etiology of acute chorea/hemiballismus, it is necessary to distinguish drugs first and then focus on metabolic causes. The most important etiological causes that may provoke acute/subacute onset chorea/hemiballismus are hypo-hyperglycemia and electrolyte disorders. In this study, we aim to present 19 patients who were admitted to our clinic with movement disorder with acute/subacute onset and diagnosed with chorea/hemiballismus.

METHODS

The study was completed with 19 patients. Routine biochemistry, HbA1c level, hemogram, sedimentation, CRP, hepatitis panels, detailed infective parameters, HIV, vitamin B12 level, folate levels, and thyroid function tests were studied. All patients underwent neuro-imaging.

RESULTS

16(84.2%) were female and 3(15.8%) were male. The lowest age of the patients was 48 years, the highest age was 89 years, and the mean age was 72.21 years. Thirteen (68.42%) patients had a diagnosis of diabetes mellitus in their history. The blood glucose levels of these patients at the time of admission: the lowest was 99 mg/dl and the highest was 1200 mg/dl. HbA1c values of 11(84.61%) of the 13 patients were also found elevated. Thirteen (68.4%) patients had hemiballismus, 4(21.1%) patients had bilateral choreoathetosis in the four extremities, and 2(10.2%) patients had ballism limited to one upper extremity.

CONCLUSIONS

Chorea/hemiballismus is a movement disorder that is rare and can occur due to a wide range of etiologies. The most common metabolic cause is NKHHS.

A Rare Case of Hyperglycemic-Hemichorea in a Young Patient

Chorea is an abnormal, nonrhythmic, and purposeless movement of limbs. There is a long list of diseases responsible for chorea; long-standing hyperglycemia can sometimes result in it, which typically manifests on one side of the body. MRI brain is an added diagnostic tool, which commonly shows hyperintense basal ganglia lesion on T1-weighted images. Chorea in the context of hyperglycemia is a reversible and infrequent occurrence, best managed with insulin and haloperidol combination therapy. Here, we discuss a patient with hyperglycemic-hemichorea, whose symptoms resolved completely within two months of taking insulin and haloperidol.

Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review

INTRODUCTION

Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH).

PATIENT CONCERNS

The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department.

DIAGNOSIS

The patient was then diagnosed with NKH chorea.

INTERVENTIONS

Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms.

OUTCOMES

Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur.

LESSONS

If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea.

CONCLUSIONS

NKH chorea is a special complication of diabetes.